| NPI | 1700361011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 77921) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH235825) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2018-10-02 |