| NPI | 1053656835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03221310) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps 33409) |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2012-12-04 |