| NPI | 1750632683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 0007439) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NY 26583) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2012-10-02 |