| NPI | 1205433810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 73904) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0016513) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2022-07-27 |