| NPI | 1235129172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 19228) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: MA 19228) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: MA 19228) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2019-08-14 |