| NPI | 1912481250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 78238) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH236997) |
| Enumeration Date | 2018-09-22 |
| Last Update Date | 2018-09-22 |