| NPI | 1730200759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: CA 56675) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 56675) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2017-01-24 |