| NPI | 1467454207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: MT 6339) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: WY 3015) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2007-08-29 |