| NPI | 1306310628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03334585) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SD 6382) |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2019-01-21 |