| NPI | 1174889059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP437347) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-1-24658) |
| 183500000X Pharmacist (Licence: FL PS44921) | |
| 1835N0905X Pharmacist Nuclear (Licence: FL NP408) | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2012-04-05 |