| NPI | 1750892873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202216311) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0010304) |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2017-10-16 |