| NPI | 1730450461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 66881) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH233858) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2012-01-26 |