| NPI | 1356775811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP036373R) |
| Additional Taxonomies | 1835G0303X Pharmacist Geriatric (Licence: PA RP036373R) |
| Enumeration Date | 2013-09-02 |
| Last Update Date | 2013-09-02 |