| NPI | 1164580056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP031558L) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: PA RP031558L) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-07-08 |