| NPI | 1396024790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 6425) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 31208) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2011-08-16 |