| NPI | 1194079822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MD 18269) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NC 06781) |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2014-05-05 |