| NPI | 1851488340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: NY 049973) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 049973) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2007-09-20 |