| NPI | 1043628035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: AL 14964) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: KS 1-09378) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: MO 028848) | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2014-07-23 |