| NPI | 1245872969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0011737) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: WV RP0011737) |
| 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: WV RP0011737) | |
| 1835P2201X Pharmacist, Ambulatory Care (Licence: WV RP0011737) | |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2019-10-14 |