| NPI | 1689676447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 17660) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 9456) |
| 1835N1003X Pharmacist Nutrition Support (Licence: MA 17660) | |
| 1835N1003X Pharmacist Nutrition Support (Licence: CT 9456) | |
| 1835P1200X Pharmacist Pharmacotherapy (Licence: MA 17660) | |
| 1835P1200X Pharmacist Pharmacotherapy (Licence: CT 9456) | |
| 1835P1300X Pharmacist Psychiatric (Licence: MA 17660) | |
| 1835P1300X Pharmacist Psychiatric (Licence: CT 9456) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2016-02-19 |