| NPI | 1861514788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 18845) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0006874) |
| 183500000X Pharmacist (Licence: PA RP441518) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2011-04-25 |