| NPI | 1386913200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS44178) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03328727) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2011-12-21 |