| NPI | 1649745118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 79193) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 20020) |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2026-03-30 |