| NPI | 1487793741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: CA PHY45471) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: CA PHY45471) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2016-08-08 |