| NPI | 1124203120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: FL PU4429) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL PU4429) |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2013-08-01 |