| NPI | 1154975837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 79032) |
| Additional Taxonomies | 1835P0200X Pharmacist, Pediatrics (Licence: CA 79032) |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2020-10-30 |