| NPI | 1821512559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 38774) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 19308) |
| 183500000X Pharmacist (Licence: VA 202213710) | |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2017-08-03 |