| NPI | 1578955126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 51378) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 67209) |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2016-09-01 |