| NPI | 1700079506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: OR 11069) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0011069) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2009-03-11 |