| NPI | 1013132414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 43968) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 10844) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2007-07-08 |