| NPI | 1073729547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: CA 58923) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 58923) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2013-07-05 |