| NPI | 1053305367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MD 16753) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: MD 16753) |
| 1835G0303X Pharmacist, Geriatric (Licence: MD 16753) | |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2007-07-08 |