| NPI | 1710252457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: WI 15726-040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 15726-040) |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2013-02-16 |