| NPI | 1760008734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CA 80980) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 80980) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2020-06-24 |