| NPI | 1104110055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 53476) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 291108-1701) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2011-06-07 |