| NPI | 1265793186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 20630) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MD 20630) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2012-06-06 |