| NPI | 1710242920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03130070) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302410772) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2012-07-13 |