| NPI | 1952309205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 20096) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 2896) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2021-01-13 |