| NPI | 1124511407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0010510) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP452590) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2019-11-02 |