| NPI | 1972138246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 10156) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 46038) |
| Enumeration Date | 2020-03-07 |
| Last Update Date | 2020-03-07 |