| NPI | 1144662115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 68590) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 057528) |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2016-02-03 |