| NPI | 1083797054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA RPH 51747) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 15127) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2022-03-31 |