| NPI | 1962814954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: CA 75323) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: ID P7128) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2019-11-15 |