| NPI | 1144287012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: VA 0202211249) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 437059) |
| 183500000X Pharmacist (Licence: NY 045917) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2015-03-02 |