| NPI | 1710984588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 6258) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: OR HD032131) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-08 |