| NPI | 1245478684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID 4540) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 39265) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2015-06-18 |