| NPI | 1386971828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist Geriatric (Licence: NC 6580) |
| Additional Taxonomies | 1835G0303X Pharmacist Geriatric (Licence: VA 0202206785) |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2009-11-04 |