| NPI | 1164850160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID p4868) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 39022) |
| 183500000X Pharmacist (Licence: NV 8868) | |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2013-10-29 |