| NPI | 1033122452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6038323-1701) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: UT 6038323-1701) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: AZ 7648) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: NE 9181) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2007-07-08 |