| NPI | 1083807267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MA 26676) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: CA 59539) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: NH 3481) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-22 |