| NPI | 1386104123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: GA RPH034290) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: NY 063554) |
| 1835P1300X Pharmacist, Psychiatric (Licence: MA PH238918) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-10-02 |