| NPI | 1821420100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: GA RPH019148) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: FL PS16182) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: AL 9548) | |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2013-08-08 |