| NPI | 1700132594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03132198) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 016168) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2012-07-30 |