| NPI | 1174061048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: FL PS11329) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: FL PU00102) |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2017-02-10 |