| NPI | 1578777868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 14040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH23336) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |