| NPI | 1366875429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: MA PH18811) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: VT 033.0052961) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2013-08-13 |