| NPI | 1306235791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 71462) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 18419) |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2015-01-22 |