| NPI | 1861462483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: WA PH00062637) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: MA 17203) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2024-06-30 |