| NPI | 1477547933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835N1003X Pharmacist Nutrition Support (Licence: MI 5302025761) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302025761) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2022-04-07 |