| NPI | 1952855397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP449971) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH.03334617-3) |
| Enumeration Date | 2016-08-14 |
| Last Update Date | 2016-08-14 |