| NPI | 1376993915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH235227) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 71942) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2016-06-14 |