| NPI | 1972032514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 50447) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 14688) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2026-01-09 |