| NPI | 1942679311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03233030) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302042406) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2015-09-16 |