| NPI | 1467739771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: CA RPH48158) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: NV 12555) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2011-11-15 |