| NPI | 1992708812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist Geriatric (Licence: FL PU5796) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS37977) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2010-11-10 |