| NPI | 1225215791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: TN 8192) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 8192) |
| 183500000X Pharmacist (Licence: SC 6852) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: SC 6582) | |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2017-01-31 |