| NPI | 1417221581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5301009765) |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2014-03-27 |