| NPI | 1245219682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1835N1003X Pharmacist Nutrition Support |
| Additional Taxonomies | 183500000X Pharmacist |
| 1835P1200X Pharmacist Pharmacotherapy | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2025-09-11 |