| NPI | 1952919094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0010302) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: WV 3159647) |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2020-07-15 |