| NPI | 1568560126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835N1003X Pharmacist, Nutrition Support (Licence: TX 37532) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: PA RP030168L) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |