| NPI | 1205171485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 57039) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03318325) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2012-11-29 |