| NPI | 1992945232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP034336R) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-2-15734) |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2009-02-26 |