| NPI | 1528488566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 68473) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS49972) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2026-02-13 |