| NPI | 1568741817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 50251) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 70486) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2015-01-05 |