| NPI | 1205157898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: FL PS44428) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 63749) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2010-06-17 |