NPI | 1023039799 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2006019794) |
Additional Taxonomies | 163WD0400X Registered Nurse, Diabetes Educator (Licence: MO 2006019794) |
183500000X Pharmacist (Licence: KS 1-14159) | |
Enumeration Date | 2006-07-21 |
Last Update Date | 2019-04-18 |