| NPI | 1538582804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 70628) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: HI ph3518) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2021-12-17 |