| NPI | 1871993972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MS 13522) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: AR 12853) |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2020-07-24 |