| NPI | 1568460202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: OK 11147) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: MD 11313) |
| 1835P1300X Pharmacist, Psychiatric (Licence: CA 31916) | |
| 1835P1300X Pharmacist, Psychiatric (Licence: NV 7229) | |
| 1835P1300X Pharmacist, Psychiatric (Licence: WA 67967) | |
| 1835P1300X Pharmacist, Psychiatric (Licence: TX 55704) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-09-01 |