| NPI | 1013261130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 65145) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202211053) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2012-10-29 |