| NPI | 1992702500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: TX 39064) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: OK 11505) |
| Enumeration Date | 2005-06-29 |
| Last Update Date | 2007-07-08 |