| NPI | 1164200952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 16563) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: MD 16563) |
| 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: MD 16563) | |
| Enumeration Date | 2023-09-21 |
| Last Update Date | 2023-09-21 |