| NPI | 1083973127 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 24709) | 
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 138342-1701) | 
| Enumeration Date | 2012-05-10 | 
| Last Update Date | 2012-05-10 |