| NPI | 1255730198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 69933) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 14730) |
| Enumeration Date | 2014-08-16 |
| Last Update Date | 2014-08-16 |