| NPI | 1386972354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 40611) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 48875) |
| 183500000X Pharmacist (Licence: NV 13151) | |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2022-10-15 |