| NPI | 1275815391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 65228) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA ph233410) |
| 183500000X Pharmacist (Licence: NH 3642) | |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2019-06-14 |