| NPI | 1063265734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: CA 90701) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: NJ 28RI04316300) |
| Enumeration Date | 2024-04-10 |
| Last Update Date | 2026-01-28 |