| NPI | 1104366020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: HI PH 2132) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: NJ 28RI02758600) |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2017-02-24 |