| NPI | 1467593392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0005804) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP041904L) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2009-03-10 |