| NPI | 1811435746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 72576) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 58039) |
| Enumeration Date | 2017-02-11 |
| Last Update Date | 2020-08-05 |