| NPI | 1407842412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: MO 2004034216) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: KS 1-14031) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2016-02-29 |