| NPI | 1700050184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 62479) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 043583) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2011-06-28 |