| NPI | 1972998771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: AZ S015506) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NM RP00007903) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2015-03-30 |