| NPI | 1437375516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: WV 6275) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 22891) |
| 1835P1200X Pharmacist Pharmacotherapy (Licence: KY 011681) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2016-05-18 |