| NPI | 1972913713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: OR 6594) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 6594) |
| 1835N1003X Pharmacist, Nutrition Support (Licence: OR 6594) | |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2014-05-01 |