| NPI | 1730307166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 21311) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: MA 21311) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2012-10-12 |