| NPI | 1104020841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: CA 37324) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: OR 7242) |
| 1835P1300X Pharmacist, Psychiatric (Licence: CO 20773) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2018-05-15 |