| NPI | 1669811147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 18358) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH.03131724-1) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2015-05-28 |