| NPI | 1346490752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS25866) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH42035) |
| 183500000X Pharmacist (Licence: VA 0202009402) | |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2008-09-22 |