| NPI | 1194096644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03217811) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS0025292) |
| Enumeration Date | 2012-01-14 |
| Last Update Date | 2012-01-14 |