| NPI | 1568885200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: CO 0020072) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0010665) |
| 183500000X Pharmacist (Licence: TX 43314) | |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2014-01-31 |