| NPI | 1629370689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 77137) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S018309) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2018-09-21 |