| NPI | 1699774612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP027347L) |
| Additional Taxonomies | 1835P1300X Pharmacist Psychiatric (Licence: PA RP027347L) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2007-07-08 |