| NPI | 1215371463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 0013977) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 055190) |
| 183500000X Pharmacist (Licence: OH 03-3-29033-3) | |
| 183500000X Pharmacist (Licence: IL 051-292451) | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2014-03-19 |