| NPI | 1154601698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-3-17021) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 009833) |
| 183500000X Pharmacist (Licence: IN 26022296A) | |
| 183500000X Pharmacist (Licence: IL 051.288102) | |
| Enumeration Date | 2011-08-27 |
| Last Update Date | 2011-08-27 |