| NPI | 1568507663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA RPH39200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 1406601701) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-07-08 |