| NPI | 1508193947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202207416) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03135370) |
| 183500000X Pharmacist (Licence: SC 35934) | |
| 183500000X Pharmacist (Licence: NC 018767) | |
| 183500000X Pharmacist (Licence: FL PS 43348) | |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2022-12-29 |