| NPI | 1568206423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 89376) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID 9561972) |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2026-03-28 |