| NPI | 1467722710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP440663) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 13853) |
| 183500000X Pharmacist (Licence: OH 03-2-28360) | |
| 183500000X Pharmacist (Licence: AZ S016337) | |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2012-01-04 |