| NPI | 1386902229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps48062) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03129764) |
| Enumeration Date | 2012-04-29 |
| Last Update Date | 2012-04-29 |