| NPI | 1477003564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 74846) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA-0019645) |
| 183500000X Pharmacist (Licence: KS 1-15650) | |
| 183500000X Pharmacist (Licence: NM RP00008089) | |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2016-10-12 |