| NPI | 1417507708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0006632) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202206369) |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2019-09-18 |