| NPI | 1649544149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist Geriatric (Licence: WA PH00021803) |
| Additional Taxonomies | 1835G0303X Pharmacist Geriatric (Licence: CA RPH37696) |
| 1835G0303X Pharmacist Geriatric (Licence: OR RPH0011603) | |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2012-02-29 |