| NPI | 1316376981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: PA RP444155) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: MD 19790) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2014-08-08 |