| NPI | 1649690348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03122830) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IN 26024971A) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2016-04-19 |