| NPI | 1659828192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: VA 0202217046) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 36616) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2019-05-08 |