| NPI | 1144636028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03234172-2) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 059237) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2014-07-11 |