| NPI | 1801880562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MD 9123) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 9123) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2025-09-11 |