| NPI | 1700980992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: MA 15491) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 15491) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2015-06-10 |