| NPI | 1366974792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 53827) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps41962) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2017-04-03 |