| NPI | 1215581327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 90781) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 20209) |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2025-06-10 |