| NPI | 1477853968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NC 19553) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: CT 4953) |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2010-10-29 |