| NPI | 1356311682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202001676) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP-026616-L) |
| 183500000X Pharmacist (Licence: WV RP00002746) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2007-07-08 |