| NPI | 1851763312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 21730) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0008096) |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2015-10-23 |