| NPI | 1568462091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP-041803-L) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: PA RP-041803-L) |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2007-07-08 |