| NPI | 1073981619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 73165) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 19104) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2017-05-11 |