| NPI | 1164753331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835N1003X Pharmacist, Nutrition Support (Licence: CO 18757) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS17282) |
| 1835N1003X Pharmacist, Nutrition Support (Licence: FL PU1952) | |
| 183500000X Pharmacist (Licence: CO 18757) | |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2012-07-02 |