| NPI | 1003174244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: VA 0202010386) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: VA 0202010386) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2012-04-25 |