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 |