| NPI | 1477145142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CO DR.0073329) |
| Additional Taxonomies | 208VP0000X (Licence: TX W8564) |
| 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: PR 36284R) | |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2026-08-31 |