| NPI | 1679852297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0007695) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 22022) |
| 183500000X Pharmacist (Licence: VA 0202210856) | |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2013-12-19 |