| NPI | 1790221208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 74990) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 21428) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-01-09 |