| NPI | 1962979971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP030195L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03337741) |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2018-10-29 |