| NPI | 1902127517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 60969) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 118443) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2010-06-17 |