| NPI | 1942806013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH26226) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 59091) |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2020-12-04 |