| NPI | 1093002974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: SD 5989) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 21442) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2015-06-04 |