| NPI | 1992224307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 76930) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: 76930.) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2022-07-21 |