| NPI | 1205363959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 74514) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 15032) |
| 183500000X Pharmacist (Licence: MT 35988) | |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2017-05-12 |