| NPI | 1134152101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: CA 57162) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS43538) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2012-08-29 |