| NPI | 1013912765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AR 6612) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2000165328) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: AR 6612) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: MO 2000165328) | |
| 1835P1300X Pharmacist, Psychiatric (Licence: AR 6612) | |
| 1835P1300X Pharmacist, Psychiatric (Licence: MO 2000165328) | |
| Enumeration Date | 2005-06-18 |
| Last Update Date | 2007-07-08 |