| NPI | 1386046852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: FL PS51330) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: KS 1-16267) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2014-09-16 |