| NPI | 1053697003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0009650) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH.03331421) |
| 183500000X Pharmacist (Licence: RI RPH04239) | |
| Enumeration Date | 2011-10-21 |
| Last Update Date | 2011-10-21 |