| NPI | 1336209378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6591909-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00006904) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: PA RP441024) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2018-01-08 |