| NPI | 1053603233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RPh0002638) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 13807) |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2011-05-06 |