| NPI | 1114212826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-3-18583) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 116284) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2011-06-10 |