| NPI | 1174650105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: CO 16737) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 16737) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2007-10-26 |