| NPI | 1912900713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: GA 10441) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: SC 4417) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2008-03-10 |