| NPI | 1457767337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 17072) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 11194) |
| 183500000X Pharmacist (Licence: OH 03225073) | |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2014-07-11 |