| NPI | 1679019574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 72578) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA ph235537) |
| Enumeration Date | 2017-01-16 |
| Last Update Date | 2017-01-16 |