| NPI | 1710320668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 043672) |
| Additional Taxonomies | 1835N1003X Pharmacist Nutrition Support (Licence: MO 043672) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2013-08-16 |