| NPI | 1609939941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MT 3784) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: MT 3784) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2014-01-10 |