| NPI | 1124088216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: TX 23922) |
| Additional Taxonomies | 1835P1300X Pharmacist Psychiatric (Licence: TX 23922) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2007-07-08 |