| NPI | 1205023991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: WV 6002) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV 6002) |
| 1835N1003X Pharmacist Nutrition Support (Licence: WV 6002) | |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2007-09-27 |