| NPI | 1396077426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 64947) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH232736) |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2011-06-28 |