| NPI | 1821410739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: MN 121874) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 16699-40) |
| 1835P1300X Pharmacist, Psychiatric (Licence: WI 16699-40) | |
| Enumeration Date | 2014-01-11 |
| Last Update Date | 2015-12-28 |