| NPI | 1033492368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: CA PHY50931) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 60763) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2013-04-23 |