| NPI | 1043505845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 63705) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03221300) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2015-05-16 |