| NPI | 1639405517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: NY 054904) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: TX 47275) |
| 1835P1300X Pharmacist, Psychiatric (Licence: GA 023615) | |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2014-02-05 |