| NPI | 1558783514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: CA 78307) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 78307) |
| 183500000X Pharmacist (Licence: VA 0202212256) | |
| 1835P1300X Pharmacist, Psychiatric (Licence: VA 0202212256) | |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2020-03-20 |