| NPI | 1295261121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835N0905X Pharmacist, Nuclear (Licence: CA RPH 51353) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 44978) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2020-05-18 |