| NPI | 1104106731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: OR 0014726) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT 5325) |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2016-07-29 |