| NPI | 1265714810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-1-16337) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV 4040) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2011-09-09 |