| NPI | 1053636738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 62492) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 14573-040) |
| 183500000X Pharmacist (Licence: IL 051.290405) | |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2010-04-06 |