| NPI | 1508283508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S017573) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 32712) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2014-03-27 |