| NPI | 1619251212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302023393) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: MI 5302023393) |
| Enumeration Date | 2011-10-01 |
| Last Update Date | 2011-10-01 |