| NPI | 1639627359 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: CA 74986)  | 
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 74986)  | 
| 1835P1300X Pharmacist, Psychiatric (Licence: CA 74986)  | |
| 1835P2201X Pharmacist, Ambulatory Care (Licence: CA 74986)  | |
| Enumeration Date | 2016-09-12 | 
| Last Update Date | 2021-12-13 |