| NPI | 1861843112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 72520) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 0020699) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2026-02-21 |