| NPI | 1942465208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: CO 19505) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: MI 5302028757) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2011-05-25 |