| NPI | 1124413604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MN 114001) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: WI 17825-40) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2015-04-01 |