| NPI | 1790815561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: ID P6053) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM 6121) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-10-05 |