| NPI | 1942207972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835N1003X Pharmacist, Nutrition Support (Licence: TX 392268) |
| Additional Taxonomies | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: TX 30326) |
| 183500000X Pharmacist (Licence: TX 30326) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2016-10-10 |