| NPI | 1265966816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH030518) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 75893) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2020-05-27 |