| NPI | 1295276525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 44376) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: TX 44376) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2017-03-20 |