| NPI | 1053692244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 22191) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P3185) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2011-09-01 |