| NPI | 1679103105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist Geriatric (Licence: SC 42190) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 42190) |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2020-01-23 |