| NPI | 1336398890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ND 5105) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH RPH.03127436-1) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2008-09-09 |