| NPI | 1154853471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 68458) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 59764) |
| 183500000X Pharmacist (Licence: WI 16146-040) | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2017-03-28 |