| NPI | 1447520796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 13711) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 66627) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2012-01-04 |