| NPI | 1114272218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302041117) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03135270) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2020-12-03 |