| NPI | 1033134788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA RPH 54219) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 461124) |
| 183500000X Pharmacist (Licence: NE 11827) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2009-12-13 |