| NPI | 1659747582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03221549) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP032355L) |
| 183500000X Pharmacist (Licence: NJ 28RI01892800) | |
| 183500000X Pharmacist (Licence: MI 5302032004) | |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2016-04-22 |