| NPI | 1114352804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 056038) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 67154) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2016-08-02 |