| NPI | 1689062853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: HI 3540) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 69196) |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2021-08-17 |