| NPI | 1194123216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 84009) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 58371) |
| Enumeration Date | 2014-12-06 |
| Last Update Date | 2025-03-05 |