| NPI | 1255040945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 88035) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 069855) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2024-02-12 |