| NPI | 1477685212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: WV 4899) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: NC 9081) |
| 1835G0303X Pharmacist, Geriatric (Licence: PA RP 039567 R) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2007-07-08 |