| NPI | 1073836425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: NY 036262) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 036262) |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2012-05-22 |