| NPI | 1811101413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 49310) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC9699) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-04-30 |