| NPI | 1235562497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 32563) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 22769) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2013-08-12 |