| NPI | 1790378610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00006572) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 53660) |
| Enumeration Date | 2021-02-12 |
| Last Update Date | 2021-02-12 |