| NPI | 1578909602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP037807R) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC004541L) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2016-10-25 |