| NPI | 1184027385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ rphs008905) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA rph47764) |
| 183500000X Pharmacist (Licence: NV 09807) | |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2014-10-01 |