| NPI | 1457358939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: CA 41487) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: CA 496216) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2020-01-13 |