| NPI | 1023126133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: VA 0202211090) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 18289) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2014-03-07 |