| NPI | 1922426105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 016948) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV rp0008310) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2014-04-03 |