| NPI | 1417394883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 68940) |
| Additional Taxonomies | 1835N1003X Pharmacist Nutrition Support (Licence: CA 68490) |
| Enumeration Date | 2013-05-25 |
| Last Update Date | 2020-01-11 |