| NPI | 1326512401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: UT 6099454-1701) |
| Additional Taxonomies | 1835P0200X Pharmacist Pediatrics (Licence: UT 6099454-1701) |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2019-01-11 |