| NPI | 1811210842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 80338) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 11362) |
| 183500000X Pharmacist (Licence: NC 18484) | |
| 183500000X Pharmacist (Licence: AZ S022935) | |
| Enumeration Date | 2010-03-04 |
| Last Update Date | 2020-01-08 |