| NPI | 1386052348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0008601) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 017250) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2014-07-22 |