| NPI | 1952767295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 73427) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 19144) |
| Enumeration Date | 2015-12-31 |
| Last Update Date | 2015-12-31 |