| NPI | 1144500299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0007755) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP445736) |
| Enumeration Date | 2011-08-21 |
| Last Update Date | 2011-08-21 |