| NPI | 1700330941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0013695) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 24320) |
| 183500000X Pharmacist (Licence: VA 0202221151) | |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2023-06-27 |