| NPI | 1811198427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0006863) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 118655) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2007-07-10 |