| NPI | 1174675300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 24999) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 4123) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2015-08-04 |