| NPI | 1730725839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P6040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03120916) |
| 183500000X Pharmacist (Licence: KY 009367) | |
| 183500000X Pharmacist (Licence: FL PS59194) | |
| Enumeration Date | 2019-11-23 |
| Last Update Date | 2019-11-23 |