| NPI | 1841773918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03438844) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP452717) |
| 183500000X Pharmacist (Licence: NY 064532) | |
| Enumeration Date | 2018-09-13 |
| Last Update Date | 2021-03-28 |