| NPI | 1861499980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: TN 11931) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 012119) |
| 1835P1300X Pharmacist, Psychiatric (Licence: MI 5302032459) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2009-05-07 |