| NPI | 1508363557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 20983) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S13751) |
| 183500000X Pharmacist (Licence: WV RP00010459) | |
| 183500000X Pharmacist (Licence: VA 0202216574) | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2018-04-06 |