| NPI | 1952872848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist Geriatric (Licence: PA RP449736) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP449736) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2022-07-05 |