| NPI | 1861499774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: TN 10358) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: AL 6970) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-08 |