| NPI | 1851508626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 111959) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: MN 111959) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-07-08 |