| NPI | 1467804948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA RPH32625) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PHY10103) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2016-07-07 |