| NPI | 1588932024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: MA PH234580) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0012001) |
| 183500000X Pharmacist (Licence: WA PH60288107) | |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2013-09-05 |