| NPI | 1356633788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0007300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202209225) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2022-12-16 |