| NPI | 1164406385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 25984) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 5174) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2011-04-10 |