| NPI | 1023067808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1300X Pharmacist Psychiatric (Licence: AZ S020081) |
| Additional Taxonomies | 1835P1300X Pharmacist Psychiatric (Licence: MO 2001019309) |
| 1835P1300X Pharmacist Psychiatric (Licence: SD R5245) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2019-03-15 |