| NPI | 1679576086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MD 13250) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: TN 008604) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2007-07-08 |