| NPI | 1144577297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH RPH03125978) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS48292) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2012-08-08 |