| NPI | 1255715009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 76043) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 021090) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2019-11-04 |