| NPI | 1154476018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 18740) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: TX 18740) |
| 1835N1003X Pharmacist, Nutrition Support (Licence: OK 13415) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2013-11-07 |