| NPI | 1285966119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 20 053656) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03228138-2) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2010-02-03 |