| NPI | 1508865403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835N1003X Pharmacist, Nutrition Support (Licence: TX 22917) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 22917) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2008-08-25 |