| NPI | 1922125186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: TX 38565) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: WA 21905) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-07-08 |