| NPI | 1396030508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03219480) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP040386R) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2011-06-15 |