| NPI | 1891032090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps35337) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: FL PS35337) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2013-01-08 |