| NPI | 1164850723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: OR 0013388) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 13388) |
| 183500000X Pharmacist (Licence: TX 35947) | |
| Enumeration Date | 2013-10-17 |
| Last Update Date | 2017-05-03 |