| NPI | 1558632075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps41961) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: FL pu6738) |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2012-01-13 |