| NPI | 1912084476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: FL 22068) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: SC 6281) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |