| NPI | 1972886075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS41843) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH 03326594) |
| Enumeration Date | 2011-09-25 |
| Last Update Date | 2011-09-25 |