| NPI | 1518256593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202208319) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0005749) |
| 183500000X Pharmacist (Licence: OH 03-3-23990) | |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2011-03-30 |