| NPI | 1215017058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 33405) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 07881) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-07-08 |