| NPI | 1194946640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 15929) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 46299) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2014-10-20 |