| NPI | 1164975298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 65239) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 12508) |
| 183500000X Pharmacist (Licence: AZ S013144) | |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2016-07-25 |