| NPI | 1124391982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03111068) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 10257) |
| 183500000X Pharmacist (Licence: GA RPH011300) | |
| 183500000X Pharmacist (Licence: MI 5302022037) | |
| 183500000X Pharmacist (Licence: HI PH-1365) | |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2012-02-09 |