| NPI | 1538169958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 040626) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: MO 040626) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2025-09-11 |