| NPI | 1316533599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 30799) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0011759) |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2024-10-30 |