| NPI | 1457643769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA RPH39341) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 8197) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2011-05-04 |