| NPI | 1508161506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 27243) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 05724) |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2011-01-21 |