| NPI | 1538170592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist Geriatric (Licence: MD 10317) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 10317) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-09-18 |