| NPI | 1952654824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 44973) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S009843) |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2012-10-17 |