| NPI | 1518248848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: KY 015565) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 015565) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2025-07-29 |