| NPI | 1790506178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 90407) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AK 230417) |
| Enumeration Date | 2024-10-18 |
| Last Update Date | 2024-10-18 |