| NPI | 1841297090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-3-12113) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202214515) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2016-06-18 |