| NPI | 1386118750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202216784) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 27712) |
| 183500000X Pharmacist (Licence: WV RP0010487) | |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2023-04-04 |