| NPI | 1043659329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 31161) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 06008569) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2013-06-19 |