| NPI | 1437442597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: KY 006238) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: FL ps11828) |
| 1835G0303X Pharmacist, Geriatric (Licence: TN 0000004574) | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2011-05-24 |