| NPI | 1679589022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: FL 1432) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MD 8384) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: CO 12726) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: FL 15672) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |