| NPI | 1386773737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NM RP4866) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NV 16622) |
| Enumeration Date | 2007-03-03 |
| Last Update Date | 2019-11-20 |