| NPI | 1659659902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 51979) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 65218) |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2019-01-29 |