| NPI | 1821379389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03127308) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302035032) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2013-05-03 |