| NPI | 1154037851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 87493) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: CA 87493) |
| Enumeration Date | 2023-01-25 |
| Last Update Date | 2026-01-18 |