| NPI | 1740732692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: IA 22613) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: IL 051.297890) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2016-10-26 |