| NPI | 1942580410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03226416) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302035818) |
| Enumeration Date | 2011-08-27 |
| Last Update Date | 2011-09-16 |