| NPI | 1700974482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835N1003X Pharmacist, Nutrition Support (Licence: CA 55191) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 55191) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2026-09-25 |