| NPI | 1366717167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: HI ph1786) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 27185) |
| 183500000X Pharmacist (Licence: MT 5929) | |
| 183500000X Pharmacist (Licence: NV 05637) | |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2012-03-13 |