| NPI | 1316606031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: NM PC00000534) |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| 1835E0208X Pharmacist, Emergency Medicine (Licence: NM RP00008393) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: NM RP00008393) | |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| Enumeration Date | 2021-12-09 |
| Last Update Date | 2025-10-30 |