| NPI | 1154441384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 8296) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 37813) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2007-07-08 |