| NPI | 1659679702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202204483) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV rp0007415) |
| Enumeration Date | 2011-03-13 |
| Last Update Date | 2011-03-13 |