| NPI | 1245595891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 4728) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: OR 4728) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2012-07-10 |