| NPI | 1578880340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0006896) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202211966) |
| 183500000X Pharmacist (Licence: PA RP448537) | |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2016-08-20 |