| NPI | 1700056157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 35403) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 13672) |
| 183500000X Pharmacist (Licence: IL 051.033604) | |
| 183500000X Pharmacist (Licence: HI 2480) | |
| Enumeration Date | 2008-03-01 |
| Last Update Date | 2021-02-18 |