| NPI | 1740200872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 17651) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: MA 17651) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: MA 17651) | |
| 1835P1300X Pharmacist, Psychiatric (Licence: MA 17651) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-08 |