| NPI | 1851745483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 39562) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 12777) |
| 183500000X Pharmacist (Licence: IA 17272) | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2016-04-20 |