| NPI | 1902173958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist Geriatric (Licence: PA RP031856L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP031856L) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2022-08-17 |