| NPI | 1932358975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: WY 3110642) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 3207) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2024-01-16 |