| NPI | 1528375326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 68880) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 3175) |
| 183500000X Pharmacist (Licence: NE 15014) | |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2017-01-10 |