| NPI | 1710169685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MN 117011) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: ND 4749) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2007-12-04 |