| NPI | 1316166994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: MD 16440) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: MI 030055) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2007-07-08 |