| NPI | 1679812804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: IN 26024088A) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: MD 20932) |
| 1835G0303X Pharmacist, Geriatric (Licence: TX 54416) | |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2015-03-19 |