| NPI | 1255454302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: UT 96-330828-1701) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: ID P5110) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2007-07-08 |