| NPI | 1578958732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP449216) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 55150) |
| 183500000X Pharmacist (Licence: WV RP0008367) | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2015-04-03 |