| NPI | 1912958505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA RPH 35653) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 07966) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2007-07-08 |