| NPI | 1235569757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835N1003X Pharmacist, Nutrition Support (Licence: KY 009321) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 009321) |
| Enumeration Date | 2013-11-19 |
| Last Update Date | 2015-07-17 |