| NPI | 1821200031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MA 23722) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: CT 8865) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-08 |