| NPI | 1699060772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 56602) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 043715) |
| 183500000X Pharmacist (Licence: NV 15281) | |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2011-06-16 |