| NPI | 1346628914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: TX 28503) |
| Additional Taxonomies | 1835N1003X Pharmacist Nutrition Support (Licence: TX 28503) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2015-05-14 |