| NPI | 1518150077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 59396) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 044756) |
| Enumeration Date | 2007-08-19 |
| Last Update Date | 2019-03-17 |