| 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 |