| NPI | 1255098166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302413871) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03441156) |
| Enumeration Date | 2021-11-26 |
| Last Update Date | 2021-11-26 |