| NPI | 1083981542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: MD 25710) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202012794) |
| 183500000X Pharmacist (Licence: OH 03321715) | |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2019-05-15 |