| NPI | 1164895207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 35894) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 5220) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2015-11-12 |