| NPI | 1013382324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: TX 53151) |
| Additional Taxonomies | 1835P2201X Pharmacist Ambulatory Care (Licence: TX 53151) |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2017-05-03 |