| NPI | 1104853555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MD 10264) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 10264) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2009-06-08 |