| NPI | 1477899136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV WV0007970) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP446860) |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2016-02-08 |