| NPI | 1326461120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA ca48948) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 13226) |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2020-01-17 |