| NPI | 1164746277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-3-21664) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH025008) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2010-03-18 |