| NPI | 1063409340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302027850) |
| Additional Taxonomies | 1835G0303X Pharmacist Geriatric (Licence: MI 5302027850) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2008-04-01 |