| NPI | 1821081910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CA PHY 470830) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH 50909) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA 5527150001) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2023-03-07 |