| NPI | 1962843581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: FL PS25140) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PU 4150) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2013-07-11 |