| NPI | 1366727331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 56162) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0019847) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2020-09-15 |