| NPI | 1396144275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP449100) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RPI008952) |
| 183500000X Pharmacist (Licence: WV 9043) | |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2020-03-29 |