| NPI | 1225541998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 76581) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 55264) |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2017-11-15 |