| NPI | 1629482120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2013020272) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03233091) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2014-06-12 |