| NPI | 1205000577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-1-10966) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202006763) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-05-09 |