| NPI | 1235586579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: CA 62172) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 62172) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2016-05-18 |