NPI | 1164797353 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: WI 15547-40) |
Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: OH 03129816) |
Enumeration Date | 2012-03-20 |
Last Update Date | 2012-03-20 |