| NPI | 1871069310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 125332) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 79678) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2022-09-12 |