| 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 |