| NPI | 1548666548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 39028) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 11883) |
| 183500000X Pharmacist (Licence: NY 36178) | |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2014-11-18 |