| NPI | 1023628773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302026337) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: MI 5302026337) |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2021-02-10 |