| NPI | 1306859913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 14915) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: IA 14915) |
| 1835P1300X Pharmacist, Psychiatric (Licence: IA 14915) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-08-10 |