| NPI | 1992790794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL 25164) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: FL 25164) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2007-07-11 |