| NPI | 1851776298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 72600) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 56360) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2015-07-28 |