| NPI | 1265977177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P0200X Pharmacist Pediatrics (Licence: CA 69852) |
| Additional Taxonomies | 1835P0200X Pharmacist Pediatrics (Licence: MA PH236329) |
| Enumeration Date | 2017-01-01 |
| Last Update Date | 2017-01-01 |