| NPI | 1861037236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: FL 46290) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: FL 9192813) |
| Enumeration Date | 2019-11-08 |
| Last Update Date | 2019-11-08 |