| NPI | 1982693628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME 4043) |
| Additional Taxonomies | 1835N1003X Pharmacist Nutrition Support (Licence: ME 4043) |
| Enumeration Date | 2005-10-16 |
| Last Update Date | 2007-07-08 |