| NPI | 1962778670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 49345) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 9097) |
| 183500000X Pharmacist (Licence: NV 13125) | |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2012-03-27 |