| NPI | 1376099317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA phy54665) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH30356) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2023-08-22 |