| NPI | 1063515393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: ME 3564) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: NH R815) |
| 1835P1200X Pharmacist Pharmacotherapy (Licence: MA 17158) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2007-07-08 |