| NPI | 1255643003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH rph.03129465) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP443980) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2010-07-09 |