| NPI | 1417253923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NC 17814) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: AL 15679) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2011-01-31 |