| NPI | 1497993901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: MD 19006) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 19006) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2020-03-31 |