| NPI | 1801348693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 27444) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 019188) |
| 183500000X Pharmacist (Licence: WV RP0009929) | |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2018-01-13 |