| NPI | 1790665875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: VA 0202218900) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: MI 5302046781) |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2025-09-08 |