| NPI | 1174993323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: OR 0013706) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: TX 49759) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: MD 20863) | |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2015-09-30 |