| NPI | 1285705483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 58683) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 52913) |
| Enumeration Date | 2006-11-11 |
| Last Update Date | 2025-08-30 |