| NPI | 1780738039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-1-12306) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302034985) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-08 |