| NPI | 1538277041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: WA PH00047783) |
| Additional Taxonomies | 1835P1300X Pharmacist Psychiatric (Licence: AZ 14763) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2007-07-08 |