| NPI | 1306843636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: MD 18190) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: TX 41917) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2010-01-19 |