| NPI | 1992700157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA RPH29784) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 13242) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2007-07-08 |