| NPI | 1114010527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA rph38785) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: CA PHY468660) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2007-12-17 |