| NPI | 1457327348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03-2-13975) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 030912) |
| 183500000X Pharmacist (Licence: NE 10406) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2010-12-15 |