| NPI | 1861685323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: MA 26912) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 26912) |
| Enumeration Date | 2007-08-19 |
| Last Update Date | 2007-08-19 |