| NPI | 1912682154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 65136) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17673) |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2023-06-15 |