| NPI | 1255749768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 41093) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 09540) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2014-07-28 |