| NPI | 1679570501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: FL PS18013) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: CA RPH55874) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2016-12-22 |