| NPI | 1780907287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 030340) |
| Additional Taxonomies | 1835N1003X Pharmacist Nutrition Support (Licence: NY 030340) |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2010-03-11 |