| NPI | 1831464361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP442730) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RPI000911) |
| 183500000X Pharmacist (Licence: OH RPH03328896-3) | |
| Enumeration Date | 2012-03-16 |
| Last Update Date | 2012-03-16 |