| NPI | 1235524778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 74940) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA IR60238147) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2020-08-04 |