| NPI | 1144594532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 7463) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 39414) |
| 183500000X Pharmacist (Licence: AK 1807) | |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2012-03-02 |