| NPI | 1710086483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 030072-1) |
| Additional Taxonomies | 1835N1003X Pharmacist Nutrition Support (Licence: NY 030072-1) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2007-07-08 |