| NPI | 1366846941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 71422) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 19831) |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2023-10-27 |