| NPI | 1174073738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 75008) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 017860) |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2016-10-07 |