| NPI | 1518287234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP032836L) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: PA RP032836L) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2010-06-04 |