| NPI | 1619347994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MI 5302035707) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NC 24956) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: HI PH-3076) | |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2015-09-30 |