| NPI | 1578769121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835N1003X Pharmacist, Nutrition Support (Licence: CT 10464) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 10464) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2024-09-13 |