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 |