| NPI | 1750854501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-37381) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 18978-40) |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2020-06-04 |