| NPI | 1801220009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 233180) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 63359) |
| 122300000X Dentist (Licence: MA DN1857243) | |
| Enumeration Date | 2013-08-25 |
| Last Update Date | 2016-06-05 |