| NPI | 1700085990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0007079) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 07774) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2008-04-26 |