| NPI | 1861004517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 93088) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 46639) |
| Enumeration Date | 2020-08-23 |
| Last Update Date | 2026-09-25 |