| NPI | 1871153874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 77902) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS55807) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2022-07-29 |