| NPI | 1457515074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P0200X Pharmacist, Pediatrics (Licence: SC 14131) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0007105) |
| Enumeration Date | 2008-07-13 |
| Last Update Date | 2024-03-26 |