| NPI | 1285964197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835N1003X Pharmacist, Nutrition Support (Licence: DC PH00000655) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: TX 30711) |
| 1835N1003X Pharmacist, Nutrition Support (Licence: NJ 29RI03240500) | |
| 1835N1003X Pharmacist, Nutrition Support (Licence: MD 19342) | |
| 1835N1003X Pharmacist, Nutrition Support (Licence: PA RP442622) | |
| 1835N1003X Pharmacist, Nutrition Support (Licence: NY 053358-1) | |
| Enumeration Date | 2009-12-28 |
| Last Update Date | 2009-12-28 |