| NPI | 1114112695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-09230) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0003216) |
| 183500000X Pharmacist (Licence: PA RP026324L) | |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2007-09-07 |