| NPI | 1578861852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MA 17340) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: WA 16837) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: FL 20514) | |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2011-03-10 |