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 |