| NPI | 1679984850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: OR 7715) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 7715) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2014-05-09 |