| NPI | 1639442858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: UT 6450026-1701) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: UT 6450026-8911) |
| Enumeration Date | 2012-02-18 |
| Last Update Date | 2012-02-18 |