| NPI | 1053113944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA RPH90360) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P11282) |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-03-24 |