| NPI | 1760842983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0007992) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202211792) |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2016-03-01 |