| NPI | 1811392731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202212286) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0007875) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2014-11-04 |