| NPI | 1942619028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: NC 24168) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: VA 0202213013) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2014-08-04 |