| NPI | 1609562131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P9212) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 30904) |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2023-08-21 |