| NPI | 1376975755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 69035) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 54191) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2016-10-29 |