| NPI | 1639744287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 28762) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: NC 28762) |
| 1835P1300X Pharmacist Psychiatric (Licence: NC 28762) | |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-05-25 |