| NPI | 1548569932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS48872) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: VA 0202011373) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2012-09-10 |