| NPI | 1548698038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0006878) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202207840) |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2013-10-22 |