| NPI | 1154377018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS23699) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: FL PU3726) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2007-07-08 |