| NPI | 1972926384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 24514) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 39742) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2014-01-22 |