| NPI | 1790391357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV 0012154) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 021335) |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2020-09-18 |