| NPI | 1588662175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: MA 15861) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MA 15861) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2013-01-24 |