| NPI | 1154081214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0002X Pharmacy, Clinic Pharmacy |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: CA 85638) |
| Enumeration Date | 2021-12-29 |
| Last Update Date | 2025-02-09 |