| NPI | 1568943470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist Ambulatory Care (Licence: WY 3134) |
| Additional Taxonomies | 1835P0018X Pharmacist Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: WY 3134) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2018-08-28 |