| NPI | 1336377449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 21577) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-3-18492) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2018-11-11 |