| NPI | 1114019601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: MO 040912) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 9786) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2013-07-22 |