| NPI | 1245391325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: VT 033.0003686) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: NH 2225) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2015-10-26 |