| NPI | 1891888111 |
|---|---|
| Former Name | MARIO ALFREDO JIMENEZ |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA RPH31058) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA 0975410001) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2007-12-19 |