| NPI | 1770184897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 57326) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302033286) |
| 183500000X Pharmacist (Licence: OH 03223424) | |
| 183500000X Pharmacist (Licence: KY 019156) | |
| 183500000X Pharmacist (Licence: CO 0020190) | |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2020-11-04 |