| NPI | 1215276985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 21823) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: TX 21823) |
| Enumeration Date | 2013-01-31 |
| Last Update Date | 2013-01-31 |