| NPI | 1093830309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 51056551701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV rp0006943) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: VA 0202208148) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: MD 18801) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2009-08-22 |