| NPI | 1790048783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: SD 5957) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SD 5957) |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2024-02-29 |