| NPI | 1235159351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NE 10804) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 10804) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2016-01-12 |