| NPI | 1215171970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP438941) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03328825) |
| Enumeration Date | 2009-04-26 |
| Last Update Date | 2009-04-26 |