| NPI | 1518347400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 18818) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 72507) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2015-06-04 |