| NPI | 1073887444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 040342-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03317243) |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2012-03-02 |