| NPI | 1265710453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: NY 049447) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: MA PH25054) |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2012-02-01 |