| NPI | 1790767671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: WA PH60086614) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: CO 16474) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2014-02-27 |