| NPI | 1376559088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 19513) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-1-19056) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2011-01-28 |