| NPI | 1386927556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: HI PH2133) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH39664) |
| 183500000X Pharmacist (Licence: WI 10435-40) | |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2011-09-23 |