| NPI | 1992221766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 76748) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202217218) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2022-08-31 |