| NPI | 1417491374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 21314-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 75895) |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2023-01-03 |