| NPI | 1700870748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 11708) |
| Additional Taxonomies | 1835N1003X Pharmacist Nutrition Support (Licence: MD 11708) |
| 1835P1200X Pharmacist Pharmacotherapy (Licence: MD 11708) | |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2007-07-08 |