| NPI | 1952582165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MD 18105) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: CT 9953) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2007-11-15 |