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 |