| NPI | 1972966703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 74589) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S021769) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2017-07-14 |