| NPI | 1265716740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NC 24156) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 24156) |
| Enumeration Date | 2011-10-03 |
| Last Update Date | 2014-08-27 |