| NPI | 1427335439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH025074) |
| 183500000X Pharmacist (Licence: SC 12761) | |
| Enumeration Date | 2011-11-05 |
| Last Update Date | 2012-06-11 |