| NPI | 1851050793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0011693) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 021556) |
| Enumeration Date | 2021-12-08 |
| Last Update Date | 2021-12-08 |