| NPI | 1225631260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2007019773) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 55015) |
| 183500000X Pharmacist (Licence: OH 03232571) | |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2020-11-20 |