| NPI | 1609871474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: ID P4656) |
| Additional Taxonomies | 1835G0303X Pharmacist Geriatric (Licence: ID P4656) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2010-04-01 |