| NPI | 1952372203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 54701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 14041-040) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2007-07-08 |