| NPI | 1598052755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 62362) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 45610) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2019-12-05 |