| NPI | 1760766935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 68187) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ I009255) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2012-10-08 |