| NPI | 1801321567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 0024388) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 75122) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2023-05-22 |