| NPI | 1821204876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 22895) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: TX 22895) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: TX 22895) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |