| NPI | 1396295101 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: MI 5302043678)  | 
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302043678)  | 
| Enumeration Date | 2016-10-05 | 
| Last Update Date | 2023-06-09 |