| NPI | 1144576828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057780) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03131975) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2013-06-04 |