| NPI | 1629068432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2004009926) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: TX 34944) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: MO 2004009926) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: OK 11805) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2015-09-29 |