| NPI | 1144502345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 66162) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 18132) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2011-10-06 |