| NPI | 1760465017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: OH 03-1-27622) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: TX 42401) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2007-07-08 |