| NPI | 1649600172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 42575) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 3856) |
| Enumeration Date | 2013-11-19 |
| Last Update Date | 2014-12-09 |