| NPI | 1902157787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03136069) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 22847) |
| 183500000X Pharmacist (Licence: NY 059576) | |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2020-04-16 |