| NPI | 1720320260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P4491) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH 43613) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2013-03-22 |