| NPI | 1346605854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 62061) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 57706) |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2025-01-29 |