| NPI | 1962740431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: FL PS40314) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: FL PU6294) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: NC 17774) | |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2013-01-17 |