| NPI | 1780991729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202211515) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH072419) |
| 183500000X Pharmacist (Licence: OH 03334492) | |
| 183500000X Pharmacist (Licence: KY 016255) | |
| 183500000X Pharmacist (Licence: PA RP451224) | |
| 183500000X Pharmacist (Licence: WV RP0009342) | |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2021-06-23 |