| NPI | 1255324133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA rph36350) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: CA rph36350) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2007-07-08 |