| NPI | 1063784957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 66898) |
| Additional Taxonomies | 163WD0400X Registered Nurse Diabetes Educator (Licence: CA 66898) |
| 183500000X Pharmacist (Licence: NV 18159) | |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2019-02-23 |