| NPI | 1760893986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03211464) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 4949) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2014-05-09 |