| NPI | 1619970977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: CO 15337) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: SC 8554) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2007-07-08 |