| NPI | 1255613311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 14166) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA rph54550) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2011-09-15 |