| NPI | 1164717146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 122577) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 47288) |
| 183500000X Pharmacist (Licence: OH 032263864) | |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2020-04-16 |