| NPI | 1912207127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV 2739) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03309637) |
| 183500000X Pharmacist (Licence: KY 010211) | |
| 183500000X Pharmacist (Licence: NC 09475) | |
| 183500000X Pharmacist (Licence: SC PH.6633 PH) | |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2010-10-22 |