| NPI | 1538410543 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 67653) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 5287555-1701) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2012-10-01 |