| NPI | 1407074529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: MA 24887) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MA 24887) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |