| NPI | 1336186154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ND 4696) |
| Additional Taxonomies | 1835N1003X Pharmacist Nutrition Support (Licence: ND 4696) |
| 1835P1200X Pharmacist Pharmacotherapy (Licence: ND 4696) | |
| 1835P1300X Pharmacist Psychiatric (Licence: ND 4696) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2007-07-08 |