| NPI | 1629155775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: AL 14261) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: LA 16433) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: TX 38167) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |