| NPI | 1497075899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 53226) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 15562) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2010-06-08 |