| NPI | 1790061364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA RPH63423) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH232701) |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2018-07-30 |