| NPI | 1033277793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 56646) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 16546) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2013-07-01 |