| NPI | 1912324922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03216365) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL 19050) |
| 183500000X Pharmacist (Licence: GA 011684) | |
| 183500000X Pharmacist (Licence: NY 042581) | |
| 183500000X Pharmacist (Licence: WI 1487740) | |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2014-03-27 |