| NPI | 1790048981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 50222) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 14690) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2012-06-21 |