| NPI | 1972803047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 52638) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ s016486) |
| Enumeration Date | 2010-10-23 |
| Last Update Date | 2010-10-23 |