| NPI | 1184696726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MN 117976-5) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 11085) |
| 183500000X Pharmacist (Licence: OH 03-3-21527) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2013-08-23 |