| NPI | 1710649975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA RPH86021) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S025482) |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2023-05-18 |