| NPI | 1518490374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: VA 3210) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS45903) |
| 183500000X Pharmacist (Licence: TX 48427) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: DC 3140356S) | |
| Enumeration Date | 2017-04-09 |
| Last Update Date | 2017-04-09 |