| NPI | 1558610337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: OK 12737) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: TX 41985) |
| 1835G0303X Pharmacist, Geriatric (Licence: WA PH57215) | |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2012-09-07 |