| NPI | 1003155805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202009429) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 19957) |
| 183500000X Pharmacist (Licence: WV RP0007582) | |
| Enumeration Date | 2013-02-14 |
| Last Update Date | 2013-02-14 |