| NPI | 1851776389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 87757) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC PH100001086) |
| 183500000X Pharmacist (Licence: WA PH60483711) | |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2024-03-06 |