| NPI | 1104585439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: CA 84221) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 84221) |
| 1835P2201X Pharmacist, Ambulatory Care (Licence: CA 84221) | |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2022-08-04 |