| NPI | 1366436867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: IA 18843) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: WI 12808) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2012-01-31 |