| NPI | 1477089647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 29776) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 8250) |
| 183500000X Pharmacist (Licence: NV 17238) | |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2017-05-11 |