| NPI | 1295852937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 15652) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: MD 15652) |
| 1835N1003X Pharmacist, Nutrition Support (Licence: MD 15652) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: MD 15652) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |