| NPI | 1124817481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 29431) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 12917) |
| Enumeration Date | 2025-05-03 |
| Last Update Date | 2025-05-03 |