| NPI | 1417940578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P4336) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: ID P4336) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2007-07-08 |