| NPI | 1679791925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: MD 14704) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302031445) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-04-03 |