| NPI | 1073873063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH MOP022003750) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 012940) |
| 183500000X Pharmacist (Licence: AZ S016837) | |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2016-01-19 |