| NPI | 1821296724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist Geriatric (Licence: FL 14665) |
| Additional Taxonomies | 1835G0303X Pharmacist Geriatric (Licence: CA 36894) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2012-03-01 |