| NPI | 1669572947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: LA 16348) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA PA.200086) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2008-11-07 |