| NPI | 1700255270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 59559) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 23034) |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2021-12-19 |