| NPI | 1407850001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: GA RPH021809) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: OH 03325555) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2013-04-17 |