| NPI | 1326594862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0005638) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: WV RP0005638) |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2016-08-25 |