| NPI | 1669813713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AR C14966) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 68434) |
| 183500000X Pharmacist (Licence: TX 63428) | |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2020-02-04 |