| NPI | 1073862991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0004540) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 015831) |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2012-09-06 |