| NPI | 1689901183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH RPH.03129937) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP444129) |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2016-06-22 |