| NPI | 1194253161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 78258) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 35289) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2023-10-11 |