| NPI | 1184853194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 26010) |
| Additional Taxonomies | 1835G0303X Pharmacist Geriatric (Licence: TX 26010) |
| Enumeration Date | 2009-07-11 |
| Last Update Date | 2009-07-11 |