| NPI | 1457028375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 24188) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: IA 24188) |
| 202D00000X Integrative Medicine (Licence: IA 24188) | |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2026-05-08 |