| NPI | 1003289315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: NY 059889) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 73951) |
| 183500000X Pharmacist (Licence: KY 018835) | |
| 1835C0206X (Licence: NY 059889) | |
| 1835P0018X Pharmacist Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: KY 018835) | |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2023-04-27 |