| NPI | 1619494879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0015600) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 76496) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2022-07-21 |