| NPI | 1114207057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 57606) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 16838) |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2011-08-23 |