| NPI | 1528422557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 017321) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MS 12201) |
| 183500000X Pharmacist (Licence: OH 03224730) | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2016-04-06 |