| NPI | 1306925235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03119030) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302032157) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2010-09-02 |