| NPI | 1609164045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: TX 57754) |
| Additional Taxonomies | 183700000X Pharmacy Technician |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2020-01-28 |