| NPI | 1508116997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: CA 56456) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: IA 19549) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2012-09-13 |