| NPI | 1811396286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 80231) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 121899) |
| 183500000X Pharmacist (Licence: WI 17626) | |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2019-04-10 |