| NPI | 1972887057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 32632) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 8945) |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2011-10-06 |