| NPI | 1164692596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 56860) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202206572) |
| 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: CA phy48201) | |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2008-07-16 |