| NPI | 1194799361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: WA PH00042798) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: NC 07605) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2007-07-08 |