| NPI | 1689910457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202009677) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0005157) |
| Enumeration Date | 2012-12-22 |
| Last Update Date | 2012-12-22 |