| NPI | 1679897714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03107777) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 6862) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2010-03-18 |