| NPI | 1528451473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA RPH71417) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S020643) |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2015-03-16 |