| NPI | 1558708081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 68252) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 37283) |
| 183500000X Pharmacist (Licence: KY 016403) | |
| 183500000X Pharmacist (Licence: NV 18410) | |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2013-05-23 |