| NPI | 1811276793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0007710) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP445739) |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2013-03-15 |