| NPI | 1659435162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CA PHY44710) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH48666) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2008-02-07 |