| NPI | 1629554415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 78532) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 015924) |
| Enumeration Date | 2018-07-14 |
| Last Update Date | 2018-07-14 |