| NPI | 1083395875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 29308) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0013826) |
| Enumeration Date | 2023-07-26 |
| Last Update Date | 2023-08-02 |