| NPI | 1528471398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 15223) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0006203) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2014-06-09 |