| NPI | 1649577784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 12378) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH23654) |
| 183500000X Pharmacist (Licence: IL 051-293153) | |
| 183500000X Pharmacist (Licence: NV 13738) | |
| 183500000X Pharmacist (Licence: OH 03-1-24484) | |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2011-02-25 |