| NPI | 1437447083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202206271) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0007211) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2016-07-18 |