| NPI | 1053605816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS40701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 65446) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2025-12-16 |