| NPI | 1134135999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MO 41387) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: KS 11181) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: AR 8396) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: TX 35851) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |