| NPI | 1265605141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: TX 26589) |
| Additional Taxonomies | 1835P0018X Pharmacist Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: MA 18577) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2015-03-06 |