| NPI | 1730064882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 91015) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 22732-40) |
| Enumeration Date | 2025-08-07 |
| Last Update Date | 2025-08-07 |