| NPI | 1942776539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 18009) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03439373) |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2020-11-25 |