| NPI | 1467590091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: MI 5302022917) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: MI 5302022917) |
| 3336L0003X Pharmacy, Long Term Care Pharmacy | |
| Enumeration Date | 2007-02-03 |
| Last Update Date | 2023-10-10 |