| NPI | 1124403324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PH60750654) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 060471) |
| 183500000X Pharmacist (Licence: PA RP449811) | |
| 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: WA PH60750654) | |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2026-08-25 |