| NPI | 1013073519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS26104) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: FL PU5033) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: FL PU5033) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: FL PS26104) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2007-07-08 |