| NPI | 1821621848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0010851) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP454134) |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2022-05-13 |