| NPI | 1710352307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 44352) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: HI 1503) |
| Enumeration Date | 2015-12-08 |
| Last Update Date | 2015-12-08 |