| NPI | 1447242516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CA pha378430) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA rph42362) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2008-01-22 |