| NPI | 1184973737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MS 010748) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: AL 16642) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2020-03-11 |