| NPI | 1083240048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0002X Pharmacy, Clinic Pharmacy (Licence: CA 64451) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CA 64451) |
| 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: 64451) | |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2020-03-20 |