| NPI | 1255618641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: ID P4340) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: CA 36012) |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2016-03-26 |