| NPI | 1710111257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 07769) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: KY 07769) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2009-05-12 |