| NPI | 1487969994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202219588) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0007539) |
| 183500000X Pharmacist (Licence: NY 054669) | |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2021-08-31 |