| NPI | 1568746527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: UT 10628594-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202210735) |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2018-12-03 |