| NPI | 1992975486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NC 18640) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: SC 011626) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2008-03-11 |