| NPI | 1487070363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03317260) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302025992) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2014-04-01 |