| NPI | 1528547759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0011637) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202214404) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2022-04-27 |