| NPI | 1013282490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 15090) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP 031449 L) |
| 183500000X Pharmacist (Licence: WV RP0003654) | |
| Enumeration Date | 2012-03-18 |
| Last Update Date | 2012-03-18 |