| NPI | 1104948306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA 03-1-22280) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0006034) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2007-07-08 |