| NPI | 1447257613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: FL PS21779) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: FL PU5692) |
| Enumeration Date | 2005-07-03 |
| Last Update Date | 2007-07-08 |