| NPI | 1780682799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: MN 114552) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 114552-4) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2025-01-21 |