| NPI | 1609124932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 58333) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 54579) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2017-08-04 |