| NPI | 1639489461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist Geriatric (Licence: UT 1463831701) |
| Additional Taxonomies | 1835G0303X Pharmacist Geriatric (Licence: WY 3352) |
| 1835G0303X Pharmacist Geriatric (Licence: ID P5814) | |
| 1835G0303X Pharmacist Geriatric (Licence: AZ S017935) | |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2010-10-14 |