| NPI | 1922404318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV 5181) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03119348-1) |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2014-11-12 |