| NPI | 1962731398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1300X Pharmacist Psychiatric (Licence: MA 024752) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: MA 024752) |
| Enumeration Date | 2009-12-14 |
| Last Update Date | 2015-10-07 |