| NPI | 1639310121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 61921) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 19750) |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2009-03-13 |