| NPI | 1073605275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: OK 12152) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 9909) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: OK 12152) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-25 |