| NPI | 1619200391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 18237) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 64423) |
| 183500000X Pharmacist (Licence: NE 13250) | |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2015-04-07 |