| NPI | 1497971246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: SC 11220) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: NC 18418) |
| 1835P1200X Pharmacist Pharmacotherapy (Licence: MA PH233915) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2012-07-12 |