| NPI | 1407808066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835N0905X Pharmacist Nuclear (Licence: FL NP246) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS23547) |
| 1835N1003X Pharmacist Nutrition Support (Licence: FL PS23547) | |
| 1835P1200X Pharmacist Pharmacotherapy (Licence: FL PS23547) | |
| 1835P1300X Pharmacist Psychiatric (Licence: FL PS23547) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2010-06-16 |