| NPI | 1003108796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP450406) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0007322) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2018-06-08 |