| NPI | 1174807630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 56796) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 41619) |
| Enumeration Date | 2011-10-03 |
| Last Update Date | 2011-10-21 |