| NPI | 1477553469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: KY 008002) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 8002) |
| 183500000X Pharmacist (Licence: KY 8002) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: KY 8002) | |
| 1835P1300X Pharmacist, Psychiatric (Licence: KY 8002) | |
| Enumeration Date | 2005-07-31 |
| Last Update Date | 2012-01-28 |