| NPI | 1720072119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835N1003X Pharmacist, Nutrition Support (Licence: GA RPH011942) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH011942) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2011-04-19 |