| NPI | 1164739603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: CA 65102) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17853) |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2025-01-02 |