| NPI | 1982977617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0002503) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP025163L) |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2012-02-10 |