| NPI | 1316936594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-13205) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 02-0450000) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2007-07-09 |