| NPI | 1902136765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 21265) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP00007261) |
| Enumeration Date | 2009-12-30 |
| Last Update Date | 2015-10-29 |